Bidders List Questionnaire

Connecticut Department of Transportation Bidders List Questionnaire

In accordance with Title 49, Section 26.11 of the Code of Federal Regulations, the following bidders list information for all DBE and non-DBEs who bid as subcontractors (in addition to prime contractors) must be collected by the Connecticut Department of Transportation on federally assisted contracts. CTDOT is directing prime contractors to submit the Bidders List Questionnaire with information about: 1) themselves 2) all subcontractors (DBE and non-DBE) included in the bid and 3) all firms (DBE and non-DBE) who quoted to the prime on subcontracting opportunities on the bid.
This information will be used for USDOT reporting only.
[49 CFR 26.11]: https://www.ecfr.gov/current/title-49/subtitle-A/part-26/subpart-A/section-26.11

Form Filler Email Address *

Please download and save a copy of the file linked below, type in data for all the firms you're reporting on and then upload the file here. *

Bidders List Questionnaire Excel.xlsx

File

Basic Information

Tell us about you. *

I am a prime contractor sharing information about my own firm

I am a prime contractor sharing information about my subcontractors for my bid

Project Number *

The DOT project number this submission is for

Original Date of Bid Opening*

Contractor Information

Contractor Firm Name *

Street Address *

Address 2

City *

State *

Zip Code *

Contractor Background

Is this firm currently certified as a Disadvantaged Business Enterprise? *

Yes

Please select each State in which this firm is certified as a DBE (if known)

You may select multiple states by holding Ctrl

By what agency(ies) is this firm certified as a DBE (e.g., MassDOT, NJTransit, etc.)? (if known)*

Be free to list multiple agencies if this firm is certified in more than one state.

The race of this firm's majority owner *

[49 CFR 26.11(c)(2)(iv)]

White

Black or African American

Hispanic American

Subcontinent Asian American

Native American, Alaskan or Hawaiian

Gender of this firm's majority owner *

[49 CFR 26.11(c)(2)(iv)]

Male

Female

Non-binary

List the NAICS codes applicable to each scope of work this contractor is seeking to perform as part of the bid.*

Code lookup: https://www.census.gov/naics/, [49 CFR 26.11(c)(2)(v)]

Age of this firm (in number of years) *

[49 CFR 26.11(c)(2)(vi)]

This firm's Annual Gross Receipts *

[49 CFR 26.11(c)(2)(vii)]

Less than $1 Million

$1 Million and less than $3 Million

$3 Million and less than $6 Million

$6 Million and less than $10 Million

$10 Million and less than $16 Million

$16 Million and less than $20 Million

More than $20 Million